Transurethral resection of the prostate versus transurethral holmium laser enucleation of the prostate for benign prostatic hyperplasia with bladder detrusor overactivity / 中华男科学杂志

<p><b>Objective</b>To compare and analyze the effects of transurethral resection of the prostate (TURP) and transurethral holmium laser enucleation of the prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH) with bladder detrusor overactivity.</p><p><b>METHODS</b>his study included 51 cases of BPH with bladder detrusor overactivity treated by TURP and another 58 treated by HoLEP. We evaluated the urination of the two groups of patients during the recovery period and at 3 and 6 months postoperatively.</p><p><b>RESULTS</b>There were no statistically significant differences in such baseline data as the blood PSA level, prostate volume, International Prostate Symptom Score (IPSS), and quality of life (QOL) between the two groups of patients, except in effective bladder capacity, which was higher in the TURP than in the HoLEP group (［315±59］ vs ［287±76］ ml, P<0.05). Urine storage symptoms were obviously improved in both of the groups postoperatively, with the storage symptoms score significantly decreased from 12.6±4.9 preoperatively to 7.5±3.9 at 3 months and 6.1±4.2 at 6 months after surgery in the TURP group (P<0.01) and from 13.7±5.7 to 7.9±4.2 and 7.0±5.1 in the HoLEP group (P<0.01). HoLEP manifested significant advantages over TURP in the postoperative urethral catheterization time (［2.7±0.8］ vs ［5.1±1.2］ d, P<0.05), postoperative bladder contracture time (［4.1±1.9］ vs ［5.8±2.4］ d, P<0.05), postoperative hospital stay (［4.4±1.8］ vs ［5.9±2.5］ d, P<0.05), and improvement of the maximum urinary flow rate, which was increased from (7.9±3.7) ml/s preoperatively to (16.8±4.3) ml/s at 3 months after surgery in the HoLEP group and from (8.6±3.2) ml/s to (14.6±4.3) ml/s in the TURP group (P<0.05).</p><p><b>CONCLUSIONS</b>Both TURP and HoLEP can improve bladder function and detrusor overactivity in BPH patients, with similar effects in improving urination at 3 to 6 months after surgery. However, HoLEP has more advantages over TURP during the period of postoperative recovery.</p>

Diagnostic value of lesion-directed prostate biopsy under TRUS in early detection of prostate cancer / 中华男科学杂志

<p><b>OBJECTIVE</b>To evaluate lesion-directed biopsy in improving the detection rate of early prostate cancer (PCa) and in differentiating PCa from other prostate pathological changes.</p><p><b>METHODS</b>We performed TRUS-guided prostate biopsy for 95 patients suspected of PCa, each subjected to extended random biopsy plus lesion-directed biopsy, and analyzed the sonographic characteristics and pathological findings.</p><p><b>RESULTS</b>PCa was detected in 35 of the patients (36.8%), including 16 hypoechoic (45.7%), 4 hyperechoic (11.4%), 10 isoechoic (28.6%) and 5 mixed hetero-echoic lesions (14.3%). Of the 35 PCa cases, 17 (46.2%) were within T2b, 70.6% (12/17) of which were detected by lesion-directed biopsy and 29.4% (5/17) by sextant biopsy, the former obviously higher than the latter (P < 0.05).</p><p><b>CONCLUSION</b>Lesion-directed prostate biopsy under TRUS can significantly improve the early diagnosis of prostate cancer, increase convenience and reduce patients' pain, but is not sufficient to replace traditional sextant biopsy.</p>

Estrogen receptor expression in adrenocortical carcinoma / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

<p><b>OBJECTIVE</b>Adrenocortical carcinoma (ACC) is a rare but highly malignant tumor, and its diagnosis is mostly delayed and prognosis is poor. We report estrogen receptor (ER) expression in this tumor and our clinical experiences with 17 ACC cases.</p><p><b>METHODS</b>The data of the 17 patients (9 females and 8 males, age range from 16 to 69 years, mean age of 42.6 years) with ACC were reviewed, and symptoms, diagnostic procedures, treatment, and results of follow-up were evaluated. Immunohistochemistry was used to detect ER expression in tumor samples from the 17 patients.</p><p><b>RESULTS</b>At the time of diagnosis, 4 tumors were classified as Stage I, 4 as Stage II, 3 as Stage III, and 6 as Stage IV. Eight patients demonstrated positive nuclear immunostaining of ER. The prognosis of patients with ER positive was significantly better (P<0.05) than that of patients with ER negative, with 1- and 5-year survival rates at 86% and 60% for ER-positive patients, and 38% and 0% for ER-negative patients, respectively.</p><p><b>CONCLUSION</b>ER-positivity may be one of the factors associated with a worse prognosis of ACC.</p>

Transurethral holmium laser enucleation for prostate adenoma greater than 100 g / 中华男科学杂志

<p><b>OBJECTIVE</b>To evaluate the effect of transurethral holmium laser enucleation of the prostate (HoLEP) for prostate adenoma greater than 100 g.</p><p><b>METHODS</b>Sixty BPH patients with the prostate larger than 100 g were randomized to two treatment groups of HoLEP (n = 32) and open prostatectomy (n = 28). Comparisons were made between the two groups in operating time, blood loss, bladder irrigating time, catheterization time and hospital stay, as well as in the international prostate symptom score (IPSS), quality of life (QOL) score, maximum urinary flow rate (Qmax) and postvoid residual volume (PVR) before and 3 months after the surgery.</p><p><b>RESULTS</b>Compared with the open prostatectomy group, the operating time was significantly longer (P < 0.01) but the blood loss, mean bladder irrigating time, catheterization time and hospital stay were significantly less in the HoLEP group (P < 0.01). Three-month follow-up revealed that HoLEP and open prostatectomy resulted in a similarly significant improvement in IPSS, QOL, Qmax and PVR (P < 0.01 ), with no statistical difference between the two groups (P > 0.05).</p><p><b>CONCLUSION</b>HoLEP and open prostatectomy are equally effective procedures for removal of large prostate adenomas, but the former is a better surgical option for prostate adenomas larger than 100 g for its greater safety, less pain and faster recovery.</p>